Lupus The Heart
and Lungs

Symptoms and signs

The main symptoms and signs of heart or lung
involvement are pleurisy which causes chest
pain at the end of taking a deep breath in,
shortness of breath, cough and ankle swelling.
In addition, because the drugs used to treat
patients with lupus suppress the immune
system, chest infections including pneumonia,
are increased in patients with lupus.

Pleurisy

Pleurisy is common in lupus – estimates vary
that between 30% and 60% of patients develop
this problem at some point. More severe forms
of this problem cause a collection of fluid,
pleural effusions, usually starting at the base of
the lungs but on occasions spreading up to
cover a larger proportion of the lung surface.
This fluid can constrict the lungs causing
shortness of breath. Pleurisy may be strongly
suspected from the clinical history and
examination, and confirmed on a chest x-ray. It
usually responds rapidly to a short course of
steroids.

The lungs

A number of pathological conditions can affect
the structure of the lungs themselves although
none are specific for lupus. Examples include a
form of scarring within the lungs known as
'interstitial fibrosis' which causes shortness of
breath and a 'crackling sound' when your
doctor listens to your breathing with a
stethoscope. Confirmation of this problem is
achieved with chest x-rays and CT (or MRI)
scanning. Some lupus patients are more
susceptible to blood clots and this may give
rise to a pulmonary embolus which can in turn
cause the coughing up of blood from the
lungs. A rather rare condition, known as
shrinking lung disease, is thought to be due to
a problem with the diaphragm muscle which is
found below the lung.

The heart - Pericarditis

The pericardium or tissue lining around the
heart can also become inflamed. Classically
the pain is at the centre of the chest at the front
and can even be mistaken by the patient (or
the doctor) as a heart attack. Clinical
examination, chest x-rays and an
echocardiogram help to make the distinction.
This is a less common problem than pleurisy,
but also often responds to the treatment with
steroids.

Heart valve disease

A small number of patients develop heart valve
disease. There is a strong association with the
presence of anti-phospholipid antibodies
(discussed in another fact sheet in more detail);
leaky heart valves result in shortness of breath
and should be treated with the help of a
cardiologist. Rarely patients require valve
surgery.

Heart attacks

Although the actual number of lupus patients
suffering from heart attacks is small, there is
undoubtedly an increased risk of this occurring
especially in women between the ages of thirty
five and forty five. The reasons are not entirely
clear though some 'traditional' risk factors
such as high blood pressure are more of a
problem in lupus patients (often linked to kidney disease) than in people who don't have
lupus. Other traditional factors linked to the
development of heart attacks such as a high
cholesterol can be effectively treated with drugs
called statins. Similarly anti-phospholipid
antibody effects can be minimised by the use of
Aspirin or Warfarin.

Conclusions

The heart and lungs are quite commonly
affected in patients with lupus. Pleurisy and
pericarditis can often be treated successfully
with low to moderate doses of steroids. More
emphasis is being placed on looking at the risk
factors for the development of heart attacks
including abnormalities in clotting factors and an
abnormal cholesterol level. Stopping smoking is
also a vital factor in the long-term management
of these problems.